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New Study Exposes Hidden Risks of Corticosteroid Knee Injections

  • Writer: Dr John Hong
    Dr John Hong
  • Jun 16, 2025
  • 3 min read

John K. Hong, M.D. | 6/16/2025


Knee Osteoarthritis and the Risks of Steroid Injections
Knee Osteoarthritis and the Risks of Steroid Injections

Corticosteroid (steroid) injections have long been used to relieve pain from knee osteoarthritis (OA), offering quick anti-inflammatory benefits. However, growing evidence reveals these injections may carry significant downsides—especially for the cartilage and joint structure itself.


1. Cartilage Damage & Accelerated OA


  • A recent Radiology study titled “Intra-articular Knee Injections and Progression of Knee Osteoarthritis: Data from the Osteoarthritis Initiative” (Radiology, May 27, 2025) revealed that patients receiving corticosteroid injections had significantly greater cartilage degradation over two years than both hyaluronic acid (HA) recipients and matched controls (pubmed.ncbi.nlm.nih.gov).

  • Patients showed higher MRI WORMS scores—indicating worsened cartilage, subchondral bone lesions, and meniscal damage .

  • Prior trials echo these findings: one long-term study showed repeated steroid shots led to decreased cartilage thickness (pubs.rsna.org), and animal models suggest bone weakening beneath cartilage layers .


2. Bone Health & Subchondral Changes


  • Corticosteroids may weaken the subchondral bone, increasing susceptibility to insufficiency fractures (rsna.org).

  • Structural joint alterations triggered by steroids can worsen OA pain and disability over time.


3. Short-Term Relief, Long-Term Concerns


  • Steroids reduce inflammation and pain for a few weeks to months, but evidence for lasting benefits is limited (verywellhealth.com).

  • The Radiology paper reinforces that while corticosteroids offer symptom relief, they come at the cost of faster disease progression .


Safer & Effective Alternatives


✅ Hyaluronic Acid (HA) Injections

  • Viscosupplementation enhances joint lubrication and may slow structural damage.

  • The same Radiology study showed HA recipients had less cartilage loss versus corticosteroids (verywellhealth.com, sciencedirect.com).

  • However, evidence is mixed: some reviews report little improvement over placebo, but others note benefit in mild-to-moderate OA (en.wikipedia.org).

  • Side effects are generally minimal—some discomfort or transient inflammation.


✅ Platelet-Rich Plasma (PRP)

  • PRP uses patient-derived platelets to deliver growth factors aimed at repair.

  • A well-designed Swiss RCT found PRP, HA, corticosteroids, and placebo had similar pain relief in mild/moderate OA over 6 months (pubs.rsna.org, journals.lww.com).

  • Systematic reviews suggest possible improved function with PRP, though pain relief is variable .

  • Generally well tolerated, and avoids the potential cartilage damage linked to steroids.


✅ Regenerative Therapies & Advanced Options

  • Autologous Chondrocyte Implantation (ACI) and stem-cell approaches show promise in regenerating cartilage, though use is limited to focal defects and remains under clinical investigation (thesun.co.uk).

  • Genicular artery embolisation is an emerging technique showing significant pain relief—but often indicated in later OA, not early-stage (thesun.co.uk).


Making Informed Treatment Choices

Treatment

Benefit Duration

Risks & Concerns

Best Candidates

Corticosteroids

Weeks to ~3 months

Accelerated cartilage loss, subchondral bone damage

Occasional use for acute flares

Hyaluronic Acid (HA)

Months

Limited efficacy in advanced OA, injection site flare

Mild-to-moderate OA

PRP

Weeks to months

Costs may be higher; inconsistent outcomes

Early OA, low-risk profiles

Regenerative therapies (e.g. ACI, stem cells)

Ongoing research

Limited indications, cost & access barriers

Focal defects, younger active adults

Bottom Line


The Radiology study underscores a key point: corticosteroid injections, while effective in short-term pain relief, may speed up joint degeneration (verywellhealth.com, rsna.org, sciencedirect.com, thesun.co.uk).


Patients and clinicians should weigh immediate comfort against potential long-term joint health.

For sustained benefit without structural harm, consider:

  • HA injections as a safer middle path.

  • PRP, which may aid function, especially in early OA.

  • And, when appropriate, advanced regenerative strategies.


Always consult with a specialist—orthopedist or rheumatologist—who can tailor treatments to your disease stage, activity level, and long-term joint goals.


Parkview Pain and Regenerative Institute, located in Park City and Salt Lake City, Utah, specializes in cutting edge treatments for chronic knee pain. Contact our office at (435) 714-7180 or visit parkviewpain.com for more information.


References


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